伊班膦酸盐预防肝移植术后骨质疏松症的临床效果观察

目的:观察每月口服伊班膦酸盐、维生素D3及钙剂预防肝移植术后骨质减少及骨质疏松症的临床疗效。方法:选择我院2011年1月至2013年8月收治的50例终末期肝病行尸体原位肝移植的患者,患者肝移植术后每月口服伊班膦酸钠(150mg)、维生素D3(800IE)及钙剂(1g/日),采用双能X线吸收测定法评估移植术后3个月、6个月、1年、2年腰椎及股骨颈的骨密度,同时评估骨的代谢物碱性磷酸酶(BAP)、尿吡啶诺林(PYD)、尿脱氧吡啶诺林(DPYD)的变化。结果:肝移植术后3个月患者的腰椎骨和股骨颈骨密度T值及测量值较移植前均有所下降,在持续治疗后12个月及后上升较为明显,骨密度较基线值的百分比从移植后的3个月到24个月呈稳定的上升趋势,差异有统计学意义(P0.05)。移植术后3个月的骨碱性磷酸酶较移植前明显的下降,在6、12个月时较前增加,但在24个月时再次下降。而移植术后的3、6个月的尿吡啶诺林、尿脱氧吡啶诺林上升,在12、24个月时与移植前比较无明显变化。移植后2年骨折发生率为4%。结论:每月口服1次伊班膦酸盐能显著提高肝移植术后患者第1年及第2年的骨密度,降低骨折的发生率。

Observation on the Preventive Effect of Ibandronate on the Osteoporosis after Liver Transplantation

Objective:To observed the clinical effect of ibandronate, vitamin D3 and calcium on the prevention of osteoporosis after liver transplantation.Methods:50 cases of patients with end-stage liver disease admitted in our hospital from January 2011 to August 2013 treated by row corpse orthotopic liver transplantation were selected and monthly oral ibandronate (150 mg), vitamin D3 (800IE) and calcium (1 g / day), dual-energy X-ray absorptiometry assessment were performed to detect femoral neck bone mineral density of the lumbar spine 3 months, 6 months, 1 year, 2 years after transplantation, while the changes of bone alkaline metabolites phosphatase (BAP), urinary pyridinoline (PYD), urinary deoxypyridinoline (DPYD) were also determined.Results:The T value and measured value of lumbar spine and femoral neck bone mineral density three months after liver transplantation were significantly decreased than those before transplantation, which were obviously enhanced 12 months after continuous treatment, the percentage of bone mineral density frombaseline values 3 months after transplantation to 24 months showed a steady upward trend (P <0.05). The bone alkaline phosphatase was significantly 3 months after transplantation than before transplantation, which was obviously increased increase 6 and 12 months after transplantation, but fall again 24 months after transplantation. And 3 and 6 months after the transplant, the urinary pyridinoline, urinary deoxypyridinoline rised, which had no significant change 12 and 24 months after transplantation than that, before transplantation. In 2 years after transplantation, the fracture rate was 4%.Conclusion:Ibandronate once monthly per os significantly increased the bone mineral density in the lumbar spine and femoral neck after OLT at the first year and the second year. The increased bone mineral density limits the risk of fracture.